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Provider Reimburse Admin / Provider Reimburse Admin Sr

Company: Anthem, Inc
Location: Clearwater
Posted on: February 11, 2020

Job Description:

Provider Reimburse Admin / Provider Reimburse Admin Sr - PS31797Location: Virginia, United StatesRequisition #: PS31797Post Date: Jan 16, 2020Your Talent. Our Vision. AtAnthem, Inc., its a powerful combination, and the foundation upon which werecreating greater access to care for our members, greater value for ourcustomers, and greater health for our communities. Join us and together wewill drive the future of health care .This is an exceptional opportunityto do innovative work that means more to you and those we serve at one ofAmerica's leading health benefits companies and a Fortune Top 50 Company.Provider Reimbursement Admin orProvider Reimbursement Admin Sr.Open to most locations including aremote (work-at-home) arrangementEnsures accurate adjudication ofclaims by translating provider contracts, reimbursement policies, CMSguidelines, and medical policies into effective and accurate reimbursementconfiguration in FACETS NetworX.Primary duties for both levels mayinclude, but are not limited to:

  • Reviewing provider contracts together with Anthem andCMS guidelines to ensure compliant and accurate configuration of criticalinformation systems.
  • Analyzing each new provider contract for coverage,policy, reimbursement development, and implications for system edits.
  • Configuring FACETS NetworX with provider reimbursementterms, PCAs, fee schedules, and code sets.
  • Responding to system inquiries and appeals-- primarilyin order to troubleshoot claims adjudication issues relatedto configuration.
  • Conducting research of claims systems and system editsto identify issues and to audit claims adjudication for accuracy.
  • Creating test claims and performing reviews of claimsto ensure proper configuration was used.
  • Working with other departments to resolve systemissues.
  • Working with provider contracting staff whennew/modified reimbursement contracts are needed.
  • Assisting with the analysis, documentation,configuration, and testing of current and future marketsbusiness requirements.
  • Supporting the upgrade of test environments.In addition to the above, the SR level positionserves as a subject matter expert regarding FACETS NetworXcoding conventions, reimbursement policies, provider contract language,claims testing, system edits, and FACETS backend tables.These additional primary duties mayalso include, but not limited to:
    • Works with vendors and enterprise teams to developenterprise reimbursement policies and edits, ensuring policies andedits do not conflict with Federal and statemandates.
      • Works with other departments on claims adjudicationworkflow development and business process improvements.
      • May lead the full range of provider reimbursementactivities for a state(s).
      • Leads projects related to provider reimbursementinitiatives.
      • Creates queries and performs updates to backend tablesusing SQL and/or ACCESS.
      • Serves as a mentor to less experienced administrators.ProviderReimbursement Admin / SR qualifications:TheSR level requires a BA/BS degree; 4+ years (2+ for junior level) relatedexperience; or any combination of education and experience, which wouldprovide an equivalent background.Bothlevels must have demonstrated knowledge and experience in the areas which isrequired for the role.Requirements:-Ability to handle analytical work where independent thinking and problemsolving is demonstrated-Ability to leverage data to make logical conclusions-FACETS pricing configuration, benefit build, or similar experience-FACETS NetworX experience, or similar applications-Able to run Microsoft Access queries in relation to Facets-Strong mind for process-Must know how to read and analyze a contract-Experience handling large projects-Able to use full range of Microsoft Office products proficiently Preferredskills and experience:-Inaddition to the above skills and experience, the SR level would need to possessthe ability to perform backend table updates using Microsoft Access orSQL.Anthem,Inc. is ranked as one of Americas Most Admired Companies among health insurersby Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company forDiversity. To learn more about our company and apply, please visit us atcareers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.

Keywords: Anthem, Inc, Clearwater , Provider Reimburse Admin / Provider Reimburse Admin Sr, Administration, Clerical , Clearwater, Florida

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